tbuckley/cabot-search huggingface dataset:
Abstract 15135: Preliminary Results of a Randomized Controlled Feasibility Study of an Intervention to Facilitate End-of-Life Discussions in Implantable Cardioverter Defibrillator Recipient and Informal Caregiver Dyads
Authors: Jennifer Miller, Misook L Chung, Angela Durante, Abigail Latimer, Dustin Hodges, Aaron Hesselson, Mary M Czarapata, Cecil Peppiatt, Debra K Moser
Journal: Circulation (2022)

Introduction: Mean survival following implantable cardioverter defibrillator (ICD) implantation is 2.5 years with 13% of ICD recipient deaths related to arrhythmic mechanisms and 37% related to end-stage heart failure. Despite the relatively short survival expectancy and potential of death from other causes most ICD recipients do not participate in advance care planning discussions. Information regarding communication of EOL choices between ICD recipients and informal caregivers is sparse. Objective: To determine feasibility of an internet-based dyadic communication intervention to facilitate EOL conversations between ICD recipients and informal caregivers using the Hello game, a question-based card game. Methods: The feasibility of this intervention was determined by ease of recruitment, study drop out, and participant evaluation of the intervention using a Likert-style questionnaire (0-5 with 5 being the highest rating) and open-ended questions to gather additional information to enhance the quality of the intervention. Results: From January 2021 to July 2022, a total of 38 ICD recipient (70% male, 91% white, 60 years + 11) and informal caregiver (29% male, 100% white, 56 years + 12) dyads of 97 approached (39%) in the outpatient electrophysiology clinic of an academic medical center participated in this randomized control pilot study. The majority of those who declined participation cited not having enough time. Eleven dyads (29%) dropped out after completing the consent process. No significant baseline differences were noted between the control and intervention groups. One hundred percent of intervention completers (N=9 dyads) expressed comfort regarding the intervention and highly rated the content 4.11 + .86, presentation and presenter 4.10 + .82, technology use 4.17 + .60, comfort 3.46 + .61, and conversation 4.11 + .90. Conclusion: Preliminary results indicate that this intervention is feasible and acceptable to ICD recipients and informal caregivers.
Abstract 15129: The Impact of Frailty Status on Clinical Outcomes in Middle Aged Adults Hospitalized for Heart Failure
Authors: Jeffrey Wang, Alexis K Okoh, Rebecca Steinberg, Apoorva Gangavelli, Krishan Patel, Alanna A Morris
Journal: Circulation (2022)

Introduction: The burden of frailty is high among older patients hospitalized for heart failure (HF); however, little is known about frailty in younger patients with HF. The purpose of this study is to investigate the prevalence of frailty and its association with clinical outcomes in middle aged adults hospitalized for HF. Methods: We included patients &lt;65 years old hospitalized for acute HF within a university affiliated network between 2015 to 2020. The Hospital Frailty Index was used to assess frailty risk based on ICD-10 codes. Patients were categorized into low (score &lt; 5), intermediate (score 5-15) and high (score &gt;15) risk for frailty. We investigated the association between frailty status and clinical outcomes (prolonged hospitalization [length of stay ≥ 7 day]), 30d-readmission, and 30d-mortality using multivariable logistic regression models. Results: Out of 10,170 patients (mean age 51.8±10.5 years) who were hospitalized for HF, 1129 (11.1%) were categorized as low, 3718 (36.6%) as intermediate, and 5323 (52.3%) as high risk for frailty. The proportion of patients experiencing prolonged hospitalization, 30-day readmission, and 30-day mortality was highest in the high-risk frailty group (Table). Compared to patients with low-risk frailty status, high-risk frailty status was significantly associated with prolonged hospitalization (adjusted odds ratio [aOR] 9.2, 95% Confidence Interval [CI] 7.3 - 11.5), 30-day readmission (aOR 3.7, 95% CI 2.9 - 4.7), and 30-day mortality (aOR 6.1, 95% CI 3.2 - 11.5). Compared to low risk frailty status, intermediate risk frailty status was associated with prolonged hospitalization (aOR 3.7, 95% CI 3.0 - 4.7) and 30-day mortality (aOR 3.4, 95% CI 1.8 - 6.6), but not 30-day readmission (aOR 1.34, 95% CI 0.88 - 2.05). Conclusions: Among middle aged adults hospitalized for HF, there is a high burden of frailty. We found a significant association between high-risk frailty status and worse clinical outcomes in this age group.
Abstract 15175: Differentiation Between Intramural Hematoma and Thrombosed False Lumen in Aortic Dissection Using Latest Spectral Computed Tomography With Dual-Layer Detector
Authors: Nobusada Funabashi, Kazuo Misumi
Journal: Circulation (2022)

Introduction: Differentiating intramural hematoma (IH) from a thrombosed false lumen (FL) in aortic dissection (AD) is difficult by CT since both are regarded as AD without a tear. IH may be caused by vasa vasorum rupture, and therefore differentiation should be by histology. Spectral CT with a dual layer detector can generate CT images at any keV after ordinary acquisition using virtual monoenergetic settings (VMS). Hypothesis: Using spectral CT (range 40-200 keV), and a spectral distribution of CT values for aortic true lumen (TL) and FL, we can differentiate IH from thrombosed FL in AD in early and late-phase enhanced CT values. Methods: We performed enhanced 128-slice spectral CT 7500 (Philips) scans with a dual-layer detector in 8 patients (5 males, 71±14 years), with suspected IH or thrombosed FL in AD in the ascending aorta (Group 1), and 6 patients (4 males, 67±12 years) with thrombosed FL in AD in the descending aorta (Group 2). VMS images at various keV values were created from spectral-based images. We measured TL, FL or IH lumens in axial images at each keV in early and late phases using contrast. Results: On spectral profile analysis, in Group 1, lower keV values were associated with almost no and slightly increased mean CT values for FL or IH, in early and late phases using contrast. In Group 2, lower keV values were associated with slightly and moderately increased mean CT values for FL, in early and late phases using contrast. The degree of increments in CT values in lower keV images in late phase with contrast was significantly smaller for FL or IH in ascending aortas (n=8) than for FL in descending aortas (n=6) (P&lt;0.05). Conclusions: On CT, TL, FL, and IH lumens, in early and late phases using contrast are unique. IH may be caused by vasa vasorum rupture and thrombosed FL in AD spreading contrast in late phase. This may cause a difference in the degree of increments in CT values in lower keV images in late phase using contrast for FL or IH in the ascending aorta and for FL in the descending aorta.
Abstract 15107: Comparative Therapeutic Efficacy and Mechanism of Stem Cells in Rat Myocardial Infarction Model
Authors: Muthukumar Gunasekaran, Rachana Mishra, Sudhish Sharma, Progyaparamita Saha, Swetha T Krishnan, Ling Chen, Sameer A Guru, Artur Stefanowicz, Agata Bilewska, Anshuman Sinha, Emily Ciolak, Zhi-dong Ge, Sunjay Kaushal
Journal: Circulation (2022)

Introduction: Successful cell therapy should be able to resist the hostile ischemic myocardium, should be retained for longer duration to continue secreting cardioprotective growth factors/exosomes and should not elicited immunological host response. Hypothesis: Analysis of 5 clinically relevant human stem/progenitor cells in a rodent model of acute myocardial infarction demonstrated that neonatal cardiac mesenchymal stromal cells (nMSCs) provide the strongest cardiac functional recovery. Methods: Cardiac functional outcome following nMSCs/aMSCs in rat MI model was measured by echocardiography. Transplanted cell retention, in vivo phagocytosis and CD68 + cells was assessed by immunohistochemistry. In vitro phagocytosis analysis for aMSCs/nMSCs were performed with THP-1 derived macrophages. THP-1 differentiated macrophages were validated for the expression of CD68 and absence of CD31. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used for proteomic analysis of nMSCs and aMSCs. CD47 expression in nMSCs was blocked by anti-CD47/ siRNA transections/lenti-virus expressing CD47 shRNAs approaches. CD47 knock down efficiency by siRNA and lenti-virus were validated by immunoblot. Isotype antibody, scrambled siRNA and lentivirus expressing empty vector served as control. Results: Transplanted nMSCs significantly increased the number of tissue reparative macrophages and regulatory T cells and significantly decreased monocyte-derived inflammatory macrophages and neutrophils. nMSCs also showed immune evasion in the host myocardium. mRNA microarray and single-cell analyses combined with targeted depletion studies established CD47 in nMSCs as a key molecule responsible for stem cell retention in the myocardium through an antiphagocytic mechanism regulated by miR34a-5p. Gain- and loss-of-function studies demonstrated that mir34a-5p regulated the production of exosomes and cardioprotective paracrine factors in the nMSC secretome. Conclusions: We conclude that the functional benefits of nMSCs are governed by a novel miR34a-5p pathway regulating immunomodulation, cell retention, exosome production, and cytokine secretion.
Abstract 14997: Computerized Cognitive Training and 24-Month Mortality in Heart Failure
Authors: Miyeon Jung, Bruno Giordani, Asa B Smith, David G Clark, Irmina Gradus-Pizlo, Kelly L Wierenga, Susan J Pressler
Journal: Circulation (2022)

Introduction: Long-term efficacy has not been widely evaluated for computerized cognitive training (CCT) to improve cognition and reduce mortality. The purpose of this study was to evaluate long-term efficacy of CCT to reduce risk of death and test additional predictors of long-term mortality among patients with heart failure (HF). Methods: In this prospective study, a subset of 142 patients with HF were included from the parent 3-arm RCT testing CCT using BrainHQ to improve memory. Mortality data were collected from electronic health records, family caregivers, physicians or nurses during 24 months after the randomization between Mar 2017 and Dec 2020. Multiple logistic regressions were performed with 2 predictor variables (group and an additional predictor) given the small number of death cases. Predictors tested were age, baseline global cognition, memory, working memory, depressive symptoms, and health-related quality of life (HRQL). Results: The sample was 52% women/48% men; mean age 65 (SD=13) years; and race 13% Black, 1% more than one race, 1% Native Hawaiian/Pacific Islander, and 85% White. Mean left ventricular ejection fraction was 46% (SD=14). Of 142 patients, 16 (11.3%) died; 4 (8.3% of 48) in CCT group and 12 (12.8% of 94) in control groups (p=.429). The patients who died were older by 9 years (p=.002), had more depressive symptoms (p=.022), and poorer global cognition (p=.009), memory (p=.069), and HRQL (p=.080) at baseline. In logistic regression models, CCT group was not a statistically significant predictor of 24-month mortality (OR=0.65, 95% CI=0.28-1.15). Patients with better global cognition and memory were less likely to die over 24 months by 27% (OR=0.73, 95% CI=0.58-0.90) and 19% (OR=0.81, 95% CI=0.67-0.99), respectively. Patients with more depressive symptoms (OR=1.10, 95% CI=1.00-1.21) and older age (OR=1.08, 95% CI=1.01-1.14) were more likely to die over 24 months. Working memory and HRQL did not predict mortality. Conclusions: CCT using BrainHQ did not show long-term efficacy on reducing 24-month mortality in HF. Efficacious interventions are needed that are targeted at underlying etiologies of cognitive dysfunction and depressive symptoms in older patients with HF.
Abstract 15213: Physical Activity Engagement Among African Americans, African Immigrants, Afro-Caribbeans, and Non-Hispanic White Participants in the 2010-2018 National Health Interview Survey (NHIS)
Authors: Tiwaloluwa Ajibewa, Ruth-Alma Turkson-Ocran, Yvonne Commodore-Mensah
Journal: Circulation (2022)

Introduction: Physical inactivity rates are increasing, with higher rates among non-Hispanic Black adults compared to their non-Hispanic White counterparts. However, a comparison of physical activity (PA) engagement across Black Ethnic subgroups in the U.S. has yet to be documented. The purpose of this study was to examine PA engagement rates among African American, African immigrant, and Afro-Caribbean adults compared with White adults. Hypothesis: We hypothesized that significant differences in adherence to PA recommendations across ethnic groups, with lower adherence to recommendations among the Black Ethnic subgroups compared with their White counterparts. Methods: We included data from non-Hispanic White, African American, Afro-Caribbean, and African immigrant adults from the 2010-2018 National Health Interview Survey in these analyses. Using generalized linear models, we compared levels of PA [meeting the moderate-to-vigorous physical activity (MVPA) recommendations] by race/ethnic group adjusting for age and sex. Results: Data from 202,273 adults (mean age 48 years; 31% college/graduate degree; 52% female; 32% with obesity) were included. Among the total sample 49.6% of participants met the MVPA recommendations, while 50.4% did not. Unadjusted pooled analysis across the 9-year period, showed that a majority of White participants (52%) adhered to the MVPA guidelines, compared to only 42% of African Americans, 41% of Afro-Caribbeans, and 47% of African immigrants (all p s&lt;0.01). Similarly, in adjusted models, higher levels of PA were seen among White adults (52% adhering to MVPA guidelines), compared with African American (41%), Afro-Caribbean (41%), and African immigrant adults (42%) ( p s&lt;0.01) (Table). Conclusions: Higher levels of inactivity are seen across Black subgroups in the U.S. compared with their White peers, likely contributing to higher disease burden, highlighting the importance of focused interventions within these groups.
Abstract 15183: From Insult to Injury: A Rare Consequence of Sodium Glucose Cotransporter 2 Inhibitors
Authors: Aakanksha Sharma, Apurva Sharma, Robert Kornberg
Journal: Circulation (2022)

Introduction: Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing infection associated with diabetes mellitus (DM), especially in older women. Patients can remain asymptomatic or present with severe sepsis and bacteremia due to E. Coli (58%) or K. pneumonia (21%). Herein, we present a unique case of recurrent life-threatening sepsis due to EPN in a male with Heart failure with reduced ejection fraction (HFrEF) and well controlled DM treated with a sodium-glucose cotransporter two inhibitor (SGLT2i). Case: A 74-year-old man with metabolic syndrome, HFrEF (EF 30%), chronic kidney disease (stage 2) who was started on empagliflozin by his cardiologist four days prior, presented to the emergency department with dizziness and fever for one day. Vitals were notable for temperature of 102.9F and blood pressure of 88/52 mmHg. The physical exam was unremarkable. His WBC was 16,000/dL, and lactate was 2.8. A sepsis workup revealed a urinalysis positive for cystitis along with a CT of the abdomen, which demonstrated evidence of acute right-sided emphysematous pyelonephritis (Fig. 01). Blood culture grew pan sensitive E coli. He was treated with IV Ceftriaxone 2g once daily for 14 days. His previous records unveiled that the patient was initially started on empagliflozin two months ago, followed by admission with EPN within ten days, after which the medication was held until its reintroduction before the current presentation. Conclusion: Emphysematous pyelonephritis as a complication of SGLTI2I use is remarkably under-reported. The median time of onset of disease from SGLT2i initiation is 45 days. The patient experienced his first episode of EPN within ten days and then four days after reintroduction of SGLT2i. This case illustrates the potential for severe UTIs with SGLT2i and the value of a thorough history emphasizing the history of UTIs, especially those with obstructive renal symptoms.
Abstract 15125: L-Arginine and Vitamin C Improve Symptoms of Long-COVID: Results of a Nationwide Multicenter Study
Authors: Raffaele Izzo, Valentina Trimarco, Pasquale Mone, Teresita Aloe, Massimo Capra Marzani, Antonello Diana, Giovanni Fazio, Mario Mallardo, Mauro Maniscalco, giuseppe marazzi, Nunzia Messina, SIMONE MININNI, Chiara Mussi, Girolamo Pelaia, Alfio Pennisi, Pierachille Santus, Francesco Scarpelli, Francesco Tursi, Alessandro Zanforlin, Bruno Trimarco, Gaetano Santulli
Journal: Circulation (2022)

Introduction: Mounting evidence indicates that endothelial dysfunction and oxidative stress play crucial roles in the pathophysiology of COVID-19 and Long-COVID. Hypothesis: We hypothesized that a supplementation combining L-Arginine (to improve endothelial function) and Vitamin C (to reduce oxidation) could have beneficial effects on Long-COVID symptoms. Methods: We designed a nationwide multicenter clinical study, in which a survey assessing several symptoms that have been previously associated with Long-COVID was administered to COVID-19 survivors; the subjective perception of the tolerance to the effort was measured as well, trough the Borg scale. Patients were divided in two groups, with a 2:1 ratio: the first group included patients treated with L-Arginine + Vitamin C, whereas the second group was treated with multivitaminic combinations (alternative treatment). Before administering the survey, patients completed 30 days of treatment. Results: 1590 patients were initially enrolled, of which 1390 successfully completed the study. Following a 30-day treatment with L-Arginine + Vitamin C, the survey revealed that patients in this treatment group had significantly lower scores compared to the other group. There were no other significant differences between the two groups. Furthermore, when examining the subjective perception of the tolerance to the effort (modified Borg scale), we observed a significantly lower value (p&lt;0.0001) in the L-Arginine + Vitamin C patients compared to the alternative-treatment arm. Conclusions: Our findings indicate for the first time that the supplementation with L-Arginine + Vitamin C has favorable effects in Long-COVID, in terms of reducing its typical symptoms and improving the perceived tolerance to effort.
Abstract 15215: Autophagy Inhibition Attenuate the Development and Progression of Pulmonary Hypertension
Authors: Haiyang Tang, Changlei Bao, Jian Wang, Jennifer S. Carew, Jason Yuan
Journal: Circulation (2022)

Introduction: Autophagy plays an important role in the pathogenesis of pulmonary hypertension. However, the potential therapeutic benefit of autophagy inhibition remains undetermined. Hypothesis: ROC-325 was developed as a novel small molecule lysosomal autophagy inhibitor that has demonstrated significantly more potent anticancer activity than the antimalarial drug hydroxychloroquine (HCQ). Methods: Rats with monocrotaline-induced PH (MCT-PH) and hypoxia/Sugen-induced severe PH were treated with ROC-325 and the related effects on echocardiography, hemodynamics, right ventricle hypertrophy, and pulmonary vascular remodeling were assessed. Pulmonary arterial pressure (PAP) and isometric tension were measured in isolated perfused/ventilated mouse lungs and rat PA rings. The in vitro effects on ROC-325 on autophagy, proliferation, viability, apoptosis and endothelial nitric oxide (NO) synthase (eNOS)-NO signaling were tested in human and rat pulmonary artery smooth muscle cells (PASMCs) as well as human pulmonary artery endothelial cells (PAECs) and rat pulmonary microvascular endothelial cells (PMVECs). Results and Conclusions: The therapeutic benefits of a novel lysosomal autophagy inhibitor, ROC-325, in experimental pulmonary hypertension (PH) models. Specifically, ROC-325 treatment prevents the development of monocrotaline (MCT)-induced PH, right ventricular dysfunction, and pulmonary vascular remodeling, and reverses the progression of established MCT-PH. Meanwhile, ROC-325 treatment attenuates high K + or alveolar hypoxia-induced pulmonary vasoconstriction. Mechanistically, in PASMC and PAEC, ROC-325 inhibits autophagic pathways, reduces hypoxia induced-hypoxia inducible factor (HIF) accumulation and blocks endothelial nitric oxide (NO) synthase (eNOS)-NO signaling activation. These studies illustrate the discovery of ROC-325 as a novel promising agent for PH therapy.
Abstract 15206: Significance of Electrocardiogram Changes With Exercise in Pediatric Pectus Excavatum
Authors: Karine Guerrier, Aram Bejnood, James Chang, Glenn Wetzel, Ann Hyde, Benjamin Hendrickson, Ranjit Philip
Journal: Circulation (2022)

Introduction: The change in cardiac position caused by the thoracic deformity in patients with pectus excavatum (PEX) produces characteristic electrocardiogram (ECG) findings. However, the significance of ECG changes during exercise is unknown. Hypothesis: The ECG changes with exercise in PEX are related to worsening severity of PEX and location of PEX in relation to the heart. Methods: This was a retrospective review of patients ≤19 years old that underwent an institution-based protocol for preoperative PEX evaluation with ECG, echocardiogram (TTE), chest computerized tomography (CT) and cardiopulmonary exercise test (CPET) between January 2015 and December 2021. ECG changes with exercise were compared to the severity of PEX as defined by the Haller index (HI; mild = 2-3.2, moderate = 3.2-3.5, severe &gt; 3.5) and location of the PEX as determined by right ventricular compression on CT. ECG changes were also compared to tricuspid valve annulus size (TVAS) on TTE and resting heart rate (HR) and HR reserve on CPET. Pearson's χ2 was used to compare categorical variables. Two-sample T-test was used to compare categorical with continuous variables. Results: There were 124 patients (85% male; median age 15 years [10-19 years]) with median HI 3.7 (2.4-20). Abnormal ECG changes with exercise were seen in 33 % of patients. Premature ventricular complexes (PVC) were the most frequently encountered (n=30; 73%). There was no significant difference in severity of PEX in patients with PVCs [χ2 =0.93, p 0.33; median HI of 3.9 (IQR 1.6) vs 3.7 (IQR 1.4)]. The majority of patients (96%) with PVCs had evident right ventricular compression on CT (χ2 = 5.20, p 0.02). Similarly, those with abnormal ECG changes with exercise were more likely to have a lower TVAS in comparison to those without [χ2 = 4.17, p 0.04; median TVAS z score -2.06 (IQR 1.22) vs -2.32 (IQR 0.75)]. The CPET indices were not significantly different between the two groups. Conclusions: The most frequent ECG abnormality seen with exercise in PEX in this cohort is PVCs. Lower TVAS and right ventricular compression on CT were significantly correlated with the development of PVCs with exercise. Follow-up evaluation of ECG during CPET after PEX repair may help affirm resolution of ectopy.